Personal disorders can develop out of a sudden and become the cause of numerous unpleasant issues for a person and his/her family. Therefore, it is crucial to identify the disease and provide a main diagnosis and differential diagnoses, appropriate the necessary tests. All the above mentioned is needed to provide a treatment plan for a patient. Elizabeth, from the case scenario, with a high level of certainty, suffers from depression. The symptoms (isolating at home and feeling depressed) are generally attributed to this disorder.
The two differential diagnoses in Elizabeth’s case include avoidant personality disorder and bipolar disorder. People with avoidant personality disorder avoid social situations due to fear of rejection and being judged by others (Lerner et al., 2020). Thus, it is of major importance to realize the exact original problems that caused the development of a “constantly depressed” feeling. It is crucial to understand whether anxiety and overworking might have caused mood disorders. X-rays and blood tests are beneficial in this case, as sometimes physical illnesses may stay behind the rapidly changing mood and overall state. Then psychiatrists and psychologists are to examine Elizabeth using various techniques and tests in order to assess the functioning of their personality in various spheres of life, such as family, work, etc.
Many mood and personality disorders are very hard to cure without eliminating the original negative factor that started the entire process. Thus, the most important part of a treatment plan should include constant conversations with psychologists and psychiatrists who can eventually find the original trigger. Nevertheless, it is impossible to wait and rely solely on this option. Therefore, Elizabeth should be taught new thinking and behavior patterns that can help her overcome the inner struggle before the disorder becomes constant.
References
Lerner, E., Teitelbaum, J., & Meehan, K. B. (2020). Avoidant personality disorder. In Zeigler-Hill V., & Shackelford T.K. (Eds.), Encyclopedia of Personality and Individual Differences (pp. 351–358). Springer. Web.
Defining fatigue and its patterns may help the doctor to discard the option of depression from the list of possible diagnoses. Even though the patient denies the feeling of sadness and depression, given the symptoms, it is necessary to study in more detail how she can describe her fatigue. At the level of subjective self-assessment, studies show a clear difference in all aspects of fatigue in people suffering from depression (Pedraz-Petrozzi et al., 2020). Thus, according to the patient’s personal opinion, it can be concluded whether it is worth delving further into this diagnosis. On a scale from 1 to 5, the importance of the question can be assessed by 4 due to a fairly clear description of the depression symptoms.
Based on the data obtained, it is worth considering anemia and fibromyalgia. These diagnoses may be manifested by pain in the body, fatigue, and even muscle weakness during the months preceding the appearance of noticeable swelling of the joints (Häuser et al., 2019). The patient’s symptoms, only developing the initial stage of fibromyalgia or anemia, may not be obvious at the first visit to the doctor. On a scale from 1 to 5, this question can be rated at 1 since it can significantly save time identifying the diagnosis and start timely treatment.
The issue of weight change is quite extensive and streamlined. Being one of the most common symptoms of many diseases, unexpected weight loss or gain can be assessed as changes in the nervous system, harmonic background, and even chronic diseases. It follows that on a scale from 1 to 5, this question can be safely estimated at 5 and, if necessary, asked only to confirm the final suspected diagnosis.
The question of episodes of increased activity will help the doctor consider or discard a possible bipolar disorder. Several population studies have reported that migraine and bipolar disorder have a strong and positive relationship (Jeyagurunathan et al., 2020). Also, during depressive episodes, people who have bipolar disorder are prone to increased fatigue and lack of motivation, which is also characteristic of the patient. On a scale from 1 to 5, this question can be evaluated by 2 due to similar but not obvious symptoms.
The possibility of suicide in the first place will help to determine the potentiality of depression in the patient since, in this case, this option remains the most obvious. Nevertheless, with a positive answer to the question, migraine should also be included in the list of possible diagnoses. Particular headaches and constant fatigue fit the definition of migraine and are independent predictors of suicidal thoughts and suicide attempts (Lin et al., 2019). On a scale from 1 to 5, this question can be rated at 3 since it will not exclude many other possible diagnoses but will prompt the direction of psychiatry in which it is worth continuing work.
From all of the above, the first and the most obvious diagnosis for the described syndromes is a depressive disorder. It should not be excluded even despite the patient’s claims that she does not feel depressed and sad. Another possible diagnosis is migraine and bipolar disorder, which may be less obvious behind depressive symptoms. Anemia and fibromyalgia are the least obvious but still possible options.
References
Jeyagurunathan, A., Abdin, E., Vaingankar, J. A., Chua, B. Y., Shafie, S., Chang, S. H. S.,… & Subramaniam, M. (2020). Prevalence and comorbidity of migraine headache: results from the Singapore Mental Health Study 2016. Social psychiatry and psychiatric epidemiology, 55(1), 33-43.
Häuser, W., Sarzi-Puttini, P., & Fitzcharles, M. A. (2019). Fibromyalgia syndrome: under-, over-and misdiagnosis. Clinical and Experimental Rheumatology, 37(116), 90-97.
Lin, Y. K., Liang, C. S., Lee, J. T., Lee, M. S., Chu, H. T., Tsai, C. L.,… & Yang, F. C. (2019). Association of suicide risk with headache frequency among migraine patients with and without aura. Frontiers in neurology, 10, 228.
Pedraz-Petrozzi, B., Neumann, E., & Sammer, G. (2020). Pro-inflammatory markers and fatigue in patients with depression: A case-control study. Scientific Reports, 10(1), 1-12.
The current medical landscape promotes significant advances in pharmacogenomics (PGx) implementation strategies. They support the production of new drugs by facilitating a better understanding of the genetic control of cellular functions (Baskys, 2018). More specifically, pharmacogenetic testing contributes to the personalization of medications to enhance clinical outcomes (Weitzel, Cavallari, & Lesko, 2017, p. 1552). One of its crucial applications implies the treatment of emotional lability, including bipolar disorder. Bipolar disorder is a mental health condition distressing the quality of life of the affected individual through severe emotional instability, including depression, hypomania, or mania. With that said, improved integration of the pharmacogenetics in clinical testing might enhance the overall treatment adherence in bipolar disorder patients.
Overview of Methodology
Pharmacogenetics became an increasingly valued method of investigation into the system of drug response for various diseases, including psychiatric disorders. According to Oedegaard et al. (2016), understanding the genes engaged in such a response is crucial to considerably improve the individualized treatment to target-specific genetic alterations characteristic of the particular patient or population (Fig. 1). The proposed method implies that the examined population will be divided into two groups: one is subjected to traditional psychiatric treatment, and the other group is exposed to pharmacogenetic testing. The study will also involve the implementation of clinical and laboratory supervision. Qualified and experienced psychiatric professionals engaged in the study will generally use mood stabilizers or antipsychotic drugs. As such, the healthcare provider will apply the findings of the genetic test to alter the treatment plan.
Figure 1. The pharmacogenetics implementation model (Oedegaard et al., 2016).
Hypothesis
The proposed research study will be based on the central hypothesis that pharmacogenetic testing is a beneficial tool providing efficient treatment for patients with bipolar disorder. In addition, pharmacogenetic tests help reduce the aftermath of personal instability in genetics, which needs to be recognized as a fundamental element of the response to medical treatment and drugs. The research study will be guided by the general understanding that PGx is studying genes’ response to certain medicines in the human body. Therefore, such testing is vital to determine the most appropriate treatment interventions for a broad spectrum of mental health conditions.
Study Design
The proposed scientific research will implement an observational study design. According to Bailey et al. (2019), this type of study design is based on observing the effects of a treatment or form of clinical intervention. It is followed by the record of the results or findings, without attempting to change the participants subjected to the examination procedure. The main advantage of using observational research design implies the systematic observation and record of the patients’ behavior. Therefore, it will be possible to learn and clarify the particular characteristics of the group under study or the target setting. Considering that the research involves two different groups, another critical approach will be the case-control observational studies to compare the groups and define the predictors of an outcome (Martínez, Papuzinski, Stojanova & Arancibia, 2019). The key advantage of the case-control studies is based on its simple approach to organizing and generating the hypothesis.
Setting
The proposed research study concerning the use of pharmacogenetics in treating bipolar disorder will be applied in clinical settings, with a particular focus on psychiatry.
Subjects (Population Characteristics, Inclusion and Exclusion Criteria)
The target population for the proposed research study will involve the patients diagnosed with type I or II of bipolar disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders (2013). However, the final objective is to yield results beyond the target population itself. The study will engage thirty patients with bipolar disorders divided into two groups, with fifteen individuals accordingly. The inclusion criteria start from 18 years and older (50-60 years limit), and the patients selected for the research had to take the baseline medication for at least three months. The test execution and data application for research aims will be recorded in the written form. One group of participants will be treated based on their genetic test results, while the other group of 15 people will be treated with the traditional method.
Recruitment and Attrition
Participants’ recruitment is based on the following selection criteria: age range, non-clinical stability, medication adherence, and informed consent. First, bipolar disorder diagnosis has to be recorded at least six months before the beginning of the testing and study participation. The researcher must make sure that the patients involved in the study are 18 years and older, however, under the age of 60. Furthermore, each individual will be provided with the written informed consent before participating in the pharmacogenetic test concerning legislative purposes. The baseline medication consumption for the last three months before the study is also an essential requirement.
Sample Size and Power Calculations for each Outcome Measure
The unique collected sample from 30 participants will be genotyped for GWAS (genome-wide association study). The sample for the proposed research will be assessed longitudinally with the aid of clinical scales, cognitive assessments, and laboratory tests. The STEP-BD sample will include well-documented treatment responses.
Data Collection
The data collection will be conducted with careful monitoring and accompanied by the appropriate scales. Concerning the observational research design, the most effective data collection method implies the observation of the participants. It will be adopted along with examining the non-verbal expression of feelings, identifying fundamental interactions between the patients involved, and defining changes in the selected group. The proposed research study will employ qualitative tools for data collection, such as interviews, observation, and document analysis (Cuéllar-Barboza, McElroy, Veldic, et al., 2020). Data will be gathered on the course of the disease before randomization. It will include the “age of onset for bipolar disorder, amount of prior episodes, past treatment reaction, childhood abuse, health conditions, psychoactive substance use, family history, previous lithium treatment, and prior suicide attempt history (Salloum, McCarthy, Leckband, & Kelsoe, 2015, p. 4). The participants’ history of episodes during the past two years will be used through a life chart method. In general, this information will be used as a covariate to adjust for a natural course in the statistical analysis.
Outcomes of Interest
The current studies demonstrate a relationship between variations in genetics and response to medications or disease predisposition for patients who have bipolar disorder (Espadaler, 2016). Nevertheless, the existing research does not entirely clarify whether pharmacogenetic testing can replace the current (more traditional) methods of clinical treatment. Such an open discussion poses critical challenges that the proposed research study aims to address. The outcomes of interest imply that the study will give sufficient data regarding pharmacogenetics and contribute to medication improvement for patients diagnosed with bipolar disorder. The advanced medications are expected to reduce the side effects and emphasize the pivotal role of personal genetics variability in drug response. Therefore, the main expected results are that the research findings will demonstrate promising data about the benefit of the pharmacogenetic tests measures in developing more effective and tolerated treatment in the alternative and innovative approach of bipolar disorder.
Randomization
The study participants will be randomized to pharmacogenetic test guided treatment or treatment as usual (TAU), meaning the traditional treatment approach. The patients will be divided into groups accordingly.
Measures Applied in the Research Study
The research is based on the implementation of pharmacogenetic testing and its further application to improve the clinical treatment of bipolar disorder diagnosis. As defined by the World Health Organization (WHO, 2020), there are three main prevention levels in public health: primary, secondary, and tertiary prevention. Hence, the PGx testing in the treatment of Bipolar disorder can be referred to as a primary level of public health because its measures aim at improving the overall mental health of a population affected by bipolar disorder. Pharmacogenetic testing in treating bipolar disorder is considered a mental health promotion campaign helping affected individuals access advanced treatment measures that address crucial psychiatric issues, including bipolar disorder. According to WHO (2020), such health promotion and prevention are defined as involving measures carried out to allow society to increase control over the disease and improve the overall public health outcomes.
Data Management
The previously published data regarding cognitive dysfunction in bipolar disorder and the heritability of particular neurocognitive measures will develop the evaluation strategy for the research study and define the key study domains, such as “attention, verbal learning, and executive function” (Cuéllar-Barboza, McElroy, Veldic, et al., 2020, p. 10). The gene expression data will be applied for promoting the gene expression networks that can be compared between the particular conditions. The received data can significantly contribute to the clinician’s assessment of a molecular diagnosis of bipolar spectrum disorder patients.
Data Analysis
The data analysis will be implemented with the help of SPSS, which is a software package for interactive, or batched, statistical analysis. For characterizing the patient population, the research will apply descriptive statistics and Kruskal Wallis test analysis to define the relevance of medical performance disparities of the PGx test group’s scale scores and the reference group (Salloum, McCarthy, Leckband & Kelsoe, 2015). Also, the man-Whitney U test analysis will be adapted to calculate the significance of treatment effectiveness and the aftermath differences between the reference and test samples.
Dissemination
The outcome measures of the sample might serve as a baseline sample for the future research and replication of results. The dissemination of the research findings will be focused on the target audience:
commissioning organizations,
community nursing service provider staff,
patients and the public,
external statutory organizations (Department of Health, NHS Information Centre, NICE, Quality Observatories),
academic researchers.
Potential Limitations
The pharmacogenetics studies of psychiatric conditions are exposed to some methodological issues and limitations. First, there can be a lack of reproducibility between the studies conducted so far. This can be explained by the various criteria used by many studies for examining the medications response (Fortinguerra, Sorrenti, Giusti, Zusso & Buriani, 2020). Considering the diverse criteria, the research findings cannot be directly compared between the studies. However, the International Society of Pharmacogenomics designed the recommended criteria to direct researchers in the new studies. Particular limitations derive from the complex nature of bipolar disorder.
Conclusion
Within the rapid development of the healthcare system, pharmacogenetics confronts pivotal difficulties regarding data integration into clinical practice. The existing genomic data has the power to maintain a personalized treatment approach to bipolar disorders by providing the most suitable pharmacological therapy for each individual. Pharmacogenomics can guide the clinicians towards a safer application of drugs, including antidepressant medications, based on the polymorphisms on the HTR2A gene. A pharmacogenomic test should be implemented to verify the efficiency of drugs in a given subject, predicting each medication’s effectiveness profile and safety. Such an approach will considerably improve therapeutic success and reduce the possible adverse effects.
References
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (DSM-5 (R)), 5th revised edition. American Psychiatric Association Publishing.
Bailey, R. L., Sahni, S., Chocano-Bedoya, P., Daly, R. M., Welch, A. A., Bischoff-Ferrari, H., & Weaver, C. M. (2019). Best practices for conducting observational research to assess the relation between nutrition and bone: an international working group summary. Advances in nutrition, 10(3), 391–409.
Baskys, A. (2018). Application of pharmacogenetics in clinical practice: problems and solutions. Journal of Neural Transmission, 126(1), 109–113.
Espadaler, J., Tuson, M., Lopez-Ibor, J. M., Lopez-Ibor, F., & Lopez-Ibor, M. I. (2017). Pharmacogenetic testing for the guidance of psychiatric treatment: a multicenter retrospective analysis. CNS Spectrums, 22(4), 315–324.
Fortinguerra, S., Sorrenti, V., Giusti, P., Zusso, M., & Buriani, A. (2020). Pharmacogenomic characterization in bipolar spectrum disorders. Pharmaceutics, 12(1), 13.
Martínez, D., Papuzinski, C., Stojanova, J., & Arancibia, M. (2019). General concepts in biostatistics and clinical epidemiology: observational studies with case-control design. Medwave, 19(10).
Oedegaard, K. J., Alda, M., Anand, A., Andreassen, O. A., Balaraman, Y., Berrettini, W. H., Bhattacharjee6, A., Brennand, K. J., Burdick, K. E., Calabrese, J. R., Calkin, C. V., Claasen, A., Coryell, W. H., Craig, D., DeModena, A., Frye, M., Gage, F. H., Gao, Garnham, J., Gershon, E., Jakobsen, P., Leckband, S. G., McCarthy, M. J., McInnis, M. G., Maihofer, A. X., Mertens, J., Morken, G., Nievergelt, C. M., Nurnberger, J., Pham, S., Schoeyen, H., Shekhtman, T., Shilling, P. D., Szelinger, S., Tarwater, B., Yao, J., Zandi, P. P., & Kelsoe, J. R. (2016). The Pharmacogenomics of Bipolar Disorder study (PGBD): identification of genes for lithium response in a prospective sample. BMC Psychiatry, 16(1).
Weitzel, K. W., Cavallari, L. H., & Lesko, L. J. (2017). Preemptive panel-based pharmacogenetic testing: The time is now. Pharmaceutical Research, 34(8), 1551–1555.
World Health Organization (2020). EPHO5: Disease prevention, including early detection of illness. World Health Organization, WHO. Web.
Manic-depressive psychosis is a chronic disease of the affective sphere. Currently, this disorder is referred to as bipolar affective disorder (BAD). This disease is characterized by the presence of manic, depressive, as well as mixed episodes. However, during periods of remission (improvement of the course of the disease), the symptoms of the above phases almost completely disappear. Such periods of absence of manifestations of the disease are called intermissions. There are two phases of bipolar disorder: depressive and manic.
The BAD can manifest only as a manic phase, only depressive, or only hypomanic manifestations. The number of phases, as well as their change, is individual for each patient. They can last from several weeks to 1.5-2 years (Squarcina et al., 2017). Intermissions also have different durations: they can be quite short or last up to 3-7 years (Squarcina et al., 2017). The cessation of the attack leads to an almost complete restoration of mental well-being. With BAD, there is no formation of a defect (as with schizophrenia), as well as any other pronounced personality changes, even in the case of a long course of the disease and frequent occurrence and phase change. It should be noted that the patient’s disorders can be significantly pronounced, which can lead to professional and social maladaptation.
Epidemiology
Bipolar disorder often leads to disability; according to data, this is the 12th most common cause of disability. Due to the symptoms of BAD, more people become disabled than due to asthma, and almost as many as due to coronary heart disease. Modern research shows impressive figures — more than 5% of the population suffer from bipolar spectrum disorders (Squarcina et al., 2017). Due to the difficulties of diagnosis, people learn their diagnosis only 10 years after the initial treatment, which, of course, prevents timely treatment.
The first symptoms of bipolar disorder appear at a young age. In more than half of cases it happens up to 18 years, in the vast majority of cases — up to 30 years (Rowland et al., 2018). Most often, the first episode of the disease occurs in 15-25 years (Rowland et al., 2018). At the same time, the earlier the disease begins, the more severe it is. Bipolar disorder can manifest itself both in childhood and in old age, but it happens quite rarely. As a rule, the disorder begins with depression, although men often have hypomania first. On average, one person experiences 10 episodes in his life (in the absence of treatment). However, with a rapid change of cycles, there may be more than 50 attacks of the disease.
Gender Relationships
According to statistics, type I bipolar disorder occurs with the same frequency in men and women, and type I disease is more often diagnosed in women. It is also known that the female course of the disease is characterized by rapid cycles and mixed episodes (Patel et al., 2017). Comorbid pathologies are often eating disorders, borderline personality disorder, alcohol or drug addiction, as well as the abuse of psychotropic drugs. Women are more susceptible to such somatic diseases as migraine (intense headaches), thyroid pathology, diabetes, obesity.
Men, on average, get sick about one and a half times less often than women, but they have a more complicated disease. Traditionally, men are recognized as less emotional than women. The initial period of the disease is characterized by shallow sleep, a sharp change in emotional status. Unlike women, representatives of the stronger half often suffer from a manic episode at the beginning of the disease (Patel et al., 2017). In some cases, there is a decrease in libido, sexual function is impaired. In men, in particular, a mixed type of bipolar disorder is more common. Also, unlike women, men with diagnosed bipolar disorder have periods of depression and mania lasting about the same time. It is not uncommon for bipolar disorder in men to occur against the background of frequent alcohol consumption.
Cultural Relationships
The latest medical theory connects the disease with changes in the brain, and medical practice considers pharmacological drugs to be the most effective means. Nevertheless, the growing number of people with bipolar disorder and their desire to find themselves in the world is a product of the cultural realities of modern society. The culture of industrial society creates conditions for the widespread emergence of bipolar (manic-depressive) personalities (Rowland et al., 2018). In the early stages of industrialization, there was a massive demand for a disciplined worker capable of performing monotonous work in the office and in the factory. Therefore, the normalization of those who did not meet the norm consisted of hospitalization and coercive measures of influence.
On the contrary, when industrialization reached its modern stage and monotonous work began to be performed by a robot and a computer, there was no need for coercion. Instead, it needed a creative worker who was able to cope with a large volume of extraordinary tasks in the shortest possible time, showing flexibility and the ability to act in an ever-changing environment. In essence, it demands a restless creator – a manic type of personality, energetic and unstoppable, drawing endless reserves of energy from the depths of oneself.
Pathophysiology
The study of the pathophysiology of bipolar affective disorder was also carried out on animals, in particular, mice, in which hyperactivity was induced with the help of amphetamine, while experimental mice had not only states resembling mania or some psychoses, at least with manifestations of psychomotor agitation. Another potential model of mania generation in mice was caused by a change in a gene that plays an important role in the generation of circadian rhythms. Patterns resembling mania in experimental mice included a decrease in sleep duration and an increase in activity, as well as an increase in the rewarding effect of cocaine. These changes in the mental state of the mice disappeared after the use of lithium.
Another approach to the study of the pathophysiology of bipolar affective disorder is post-mortem studies of the brain of patients suffering from bipolar affective disorder. These studies showed a decrease in the density and morphology of oligodendrocytes. Other studies have shown changes in gene expression. It should be noted that in such studies it is difficult to differentiate the effect of medications from the consequences of bipolar affective disorder. Some authors noted here a change in the regulation of genes responsible for the processes of myelination, and changes in oligodendrocytes resembled those that were noted in post-mortem studies of the brain of patients with schizophrenia. Recent post-mortem studies show changes in acetylation histones in some patients with bipolar affective disorder.
Current Treatment Options
The course of the BAD is influenced by three factors — biological, psychological and social. To minimize the impact of bipolar affective disorder on patient’s life as much as possible, you need to take control of all three factors. Work on the biological factor includes taking medications and maintaining a healthy lifestyle. In the treatment of BAD, the main role is played by drugs for mood stabilization — normotimics (lithium salts, some anticonvulsants (anticonvulsants) and antipsychotics of new generations). Supportive and preventive therapy is a long-term use of medications (antidepressants in combination with normotimics).
The disease can also resume from external influences — personal conflicts, stress and overload, so many patients also attend psychotherapy. It helps to regulate and take control of the psychological factor. The recommended type of psychotherapy for bipolar affective disorder is cognitive behavioral therapy (CBT). Psychotherapy promotes the development and harmonization of personality, which prevents the occurrence of some stressful situations (conflicts, destructive relationships).
Article Review
The authors of the article note that with an early diagnosis of BAD, it would be possible to treat the disease more effectively, and also emphasize the lack of research on the issue of treatment of BAD. Epidemiological studies suggest that “the prevalence of bipolar disorder in childhood and adolescence is 1%” (Youngstrom et al., 2017, p. 244). The article states that the clinical manifestations of bipolar disorder in prepubescent and early adolescence may differ from the manifestations of the disease in older adolescents and adults. Periods of depression alternating with euphoria, megalomania, high levels of activation, rapid confused speech, distractibility, hypersexuality, hyper religiousness, extravagance, hallucinations and delirium are characteristic of classical bipolar disorder; such a typical clinical pattern occurs, as a rule, in late adolescence and in adults. In 70% of these cases, a carefully collected anamnesis reveals at least one episode of depression preceding manic symptoms (Youngstrom et al., 2017). The authors single out the diagnosis of the early onset of symptoms of bipolar disorder as a space for further research.
References
Patel, R. S., Virani, S., Saeed, H., Nimmagadda, S., Talukdar, J., & Youssef, N. A. (2017). Gender differences and comorbidities in U.S. adults with bipolar disorder. Brain Sciences, 8(168), 1-11. doi: 10.3390/brainsci8090168
Rowland, T. A., & Marwaha, S. (2018). Epidemiology and risk factors for bipolar disorder. Therapeutic Advances in Psychopharmacology, 8(9), 251-269.doi: 10.1177/2045125318769235
Squarcina, S., Bellani, M., Rossetti, M. G., Perlini, C., Delvecchio, G., Dusi, N., … Brambilla, P. (2017). Similar white matter changes in schizophrenia and bipolar disorder: A tract-based spatial statistics study. PLOS ONE, 12(6), 1-17. doi: 10.1371/journal.pone.0178089
Youngstrom, E. A., Halverson, T. F., Youngstrom, J. K., Lindhiem, O., & Findling, R. L. (2017). Evidence-based assessment from simple clinical judgments to statistical learning: Evaluating a range of options using pediatric bipolar disorder as a diagnostic challenge. Clinical Psychology Science, 6(2), 243-265. doi: 10.1177/2167702617741845
Bipolar disorder is a mental disease that produces unexpected changes in mood, stamina, activity levels, attention, and capacity to carry out daily activities. Symptoms of manic and depressive episodes may coexist in a dissociative fugue as the disease progresses (Albashrawi, 2019). Bipolar disorder is usually identified in late teens or early adulthood as is in the case of Cheryl R. Bipolar symptoms in children are rare. Bipolar disorder may develop during or after pregnancy. Bipolar disorder is a chronic illness that needs lifetime therapy. The right medication may help individuals manage symptoms and enhance their quality of life. (Paris, 2017).
Target Symptoms
People with bipolar illness have times of abnormally strong mood, changes in sleep and activity patterns, and odd actions, frequently without realizing the consequences. According to Albashrawi (2019), mood episodes are at different intervals of time. Mood episodes are distinct from the person’s normal emotions and actions. Symptoms persist most of the time throughout an episode, which may last a day or a week.
Gloomy mood
Decreased enjoyment or interest in almost all activities
Substantial weight loss or gain, or appetite loss or gain
Insomnia vs. Hyper
Psychomotor agitation
A lack of energy
Dejection or undue guilt
Inability to concentrate or extreme indecision
Suicidal thoughts or plans; the patient has tried or planned suicide.
Medication Treatment Plan
According to Paris (2017), the management of bipolar disorder depends on the intensity of the episode and may include both psychotherapy and medication. An essential consideration is if the patient’s current medicines are triggering the incident. The antidepressants are discontinued and other mania-inducing drugs if such incidents occur. Antidepressants with discontinuation symptoms should be reduced over weeks as treatment with fluoxetine continues.
Elaboration on One Question Regarding the Case Study
Symptoms of a hypomanic episode include being inflated, expansive, and irritable for at least four days, as well as feeling irritable (Paris, 2017). In hypomania, however, symptoms are not severe enough to impede social or vocational functioning or require hospitalization, as in the case of Cheryl R, nor are they linked with psychosis. The most common and devastating form of bipolar illness is bipolar depression which is evident in the case subject, Cheryl R. More effective and safe therapies are urgently required and hence the recommended use of fluoxetine.
The patient being treated is a 26-year-old female of Korean descent. She is receiving an appointment after a 21-day hospitalization where she was diagnosed with bipolar disorder. Bipolar disorder, sometimes known as manic depression, is a mental health disorder characterized by extreme mood swings, with the patient experiencing emotional highs to the point of mania, and then rapidly transitioning to lows with deep depression and feelings of hopelessness (Mayo Clinic, n.d.). At the time of the visit, the patient is demonstrating signs of mania but controlled to an extent with a YRMS of 22 which indicates mild mania. Some elements of the case that may impact decision-making are, the patient not taking prescribed lithium medication, insight of judgment being impaired, and genetic testing demonstrating the CYP2D6*10 allele. A cautious well-researched approach should be taken to the treatment of the patient in question.
Decision #1
For the first decision, three options are presented: Lithium, Risperdal (Risperidone), and Seroquel XR (Quetiapine). All medications are approved by guidelines to be used for the acute treatment of mania in bipolar disorders. All three have confirmed double-blind, well-researched studies confirming their efficacy in treatment (Hirschfeld, n.d.). Lithium is not an option for this patient, as they have already been prescribed the medication and have a problem remaining on it, choosing to stop taking it. The patient would prefer another medication as a lithium prescription would likely result in the same outcome of abandoning the treatment plan. Left with Risperidone and Quetiapine, a study by Moosavi et al. (2015) shows that there is no significant difference between the two medications controlling acute psychotic signs and symptoms. However, according to Hirschfeld (n.d.), Seroquel XR (Quetiapine) has significantly more side effects such as weight gain, dizziness, somnolence, and dry mouth, while Risperdal (Risperidone) has nausea, somnolence, and also potentially mild weight gain. Furthermore, quetiapine is more commonly used, and the only FDA drug approved for bipolar II disorder, for the treatment of acute depressive episodes. The decision is to begin Risperdal 1mg orally BID.
Risperdal, under its generic name Risperidone, is a medication used to treat mental and mood disorders, primarily bipolar disorder, and schizophrenia. It is a second-generation antipsychotic. Its pharmacological effects rebalance dopamine and serotonin, which leads to clearer thinking, better mood, and stable behavior. It is FDA approved for acute treatment of manic or mixed episodes of bipolar disorder, as well as for long-term treatment of the bipolar disorder (National Alliance of Mental Illness, n.d.). The patient in the case is experiencing a mild manic episode of bipolar disorder. This is evident in her behavior, lack of stability, and poor insight into judgment. It is also known that this is the first visit after hospitalization after which she refused to take the prescribed lithium. Therefore, acute treatment is needed with Risperdal. It is an effective choice to stabilize the patient. According to Geddes & Miklowitz (2013), treatment of bipolar disorder should emphasize acute stabilization, bringing the patient in mania or the opposite, depression, to a euthymic and stable state, at which point there can be a focus on maintenance and relapse prevention. Therefore, by prescribing the patient Risperdal, the goal is to stabilize them for further maintenance treatment.
Psychiatry is a specialty that involves moral and ethical questions. Conditions, such as bipolar disorder, ultimately threaten or can define the patients as autonomous individuals. The conditions are also associated with suffering, disability, and stigma. When diagnosing and treating bipolar disorder, one has to follow all guidelines as there are ethical consequences. A wrong diagnosis which can lead to wrong treatment can have very negative implications. In selecting medications, there are specific risks and benefits to the core drugs used in bipolar disorder, based on age, gender, and other factors, which complicates clinical decision-making (Ostacher, 2018).
Decision #2
As a result of Decision #1 to prescribe Risperdal 1mg orally BID, the patient returns for a follow-up visit in 4 weeks, being highly sedated and lethargic. The patient is accompanied by the mother who indicates that a week after the visit, the patient is experiencing such symptoms. The choice now stands to switch completely to Lithium sustained release orally BID, or to stick with Risperdal, either 1mg at HS or 2mg at HS. The decision is to decrease Risperdal to 1mg at HS and observe.
Switching medications in the treatment of bipolar disorder is possible to achieve the best pharmacological response. Some causes for switching may include individual differences and sensitivity to side effects. However, evidence for switching remains relatively moderate to low quality, indicating potential improvements in the recurrence of mood episodes when switching between some of the conventional medications (NeuRA, 2020). Switching to Lithium is concerning as it is a significant transition in medication. As a professional, one also wants to avoid drug-induced switching in patients with bipolar disorder, where they transition from mania to depression or the other way around due to pharmacological effects (Grande et al., 2014). Furthermore, there are concerns about lithium that there were original with this patient regarding adherence. Even if lithium improves the patient’s current lethargic condition, it is not guaranteed that she will continue taking it once she is once again more aware. As for the other option of increasing Risperdal to 2mg, that is medically unnecessary. If 1mg at HS is having this lethargic effect, then increasing the dose will by all indications only worsen the state of the patient.
Therefore, decreasing the dose to 1mg at HS is the most logical decision. Notably, the initial objective of decreasing mania was achieved, and the patient stabilized. Even though they are lethargic does not indicate that they are depressed. Simply, the side effects of the dosage played a role. According to Soreff (2019), it is common and important to adjust the dosage of medication in the treatment of the bipolar disorder. Re-evaluation of treatment response should occur 2-4 weeks after initiation. Adjustments can occur via therapeutic plasma concentrations or modifying the dose until symptomatic improvement or a level of patient intolerance is reached (Soreff, 2019). Adjusting the dose and observing is a good approach to this decision. The ethical implication of this decision is that the patient’s quality of life is being concretely and adversely affected. It is necessary to decide which medication will improve the quality of life and the ability for self-sustainability.
Decision #3
After the previous decision, the patient comes in after 4 weeks with much improved symptoms. She is less sedated and lethargic, as well as showing symptoms of stability improvement with decreased YMRS score of 16, a 25% improvement. All points that Risperdal 1mg HS was effective, at both, decreasing significantly the side effects of the original dosage and providing the treatment expected for bipolar disorder. At this point, there is the option of increasing Risperdal back to 1mg orally BID, maintaining the same dosage and reassessing, or changing to Latuda 40mg orally daily. The decision made is to remain with the same dose of Risperdal and reassess.
Other options are less sensible. Increasing the dose back to 1mg orally BID poses the risk of putting the patient back into a lethargic state. Neither is there medical reasoning to do so given that the current dose at 1mg HS is working effectively. Since the client is of Asian American descent and positive for the CYP2D6*10 allele, as indicated by Chen et al. (2015) the medication has a slower clearance rate from the human system. Therefore, phenotype prediction and dose adjustment may be necessary to compensate. As a result, the Risperdal in the patient’s system was higher than normal which caused the sedation. Increasing the dosage will lead to similar side effects. Meanwhile, Latuda (lurasidone HCl) is not an option as the drug is aimed at treating bipolar depression, which the patient is not experiencing.
The decision aims to continue the trajectory of stabilization currently seen in the patient and improvement of symptoms with a reduction of side effects. It is necessary to reassess in 4 weeks to determine the treatment’s effectiveness, at which point a transition to maintenance can be made. The ethical consideration of this decision is the patient’s long-term well-being. The medication and treatment decisions made at this point have concrete effects on the health and further management of bipolar disorder.
Conclusion
The recommendations in this scenario proposed relying on Risperdal as the primary form of treatment for this specific patient’s bipolar disorder. At every decision, Risperdal was the logical option for the patient, based on her previous interaction with lithium and the potential incompatibility with other medications. As would commonly occur in practice, the Risperdal dosage was adjusted and monitored, first to account for side effects and then to consider the patient’s unique genetic characteristics. It is an acceptable and ethical course of action as it helps to find the optimal dose for the medication while avoiding any drastic transitions. In the end, the patient seems to have reached the stabilization stage in the bipolar disorder treatment, and after some observation can proceed to maintenance which would benefit her well-being and improve her quality of life.
Mental health-related issues impact human beings in various ways. Psychological issues cause behavioral change that is hard to comprehend. In Sabrina’s case, the client has bipolar disorder. Bipolar disorders are a common condition that is disabling and can be life-threatening. Bipolar disorder involves interchanging episodes of depression, mania, hypomania, or a combination. However, many clinicians face diagnostic and therapeutic challenges related to bipolar disorders (Myczkowski et al., 2018). The psychological field is essential as it focuses on achieving prevention and treatment strategies to reduce distress. Therefore, for proper treatment, a professional therapist must follow the psychiatric diagnostic criteria for the disorder. Hence, the DSM-5 is a fundamental and reliable criterion for accurately diagnosing mental health conditions.
Presented Problem
Depression and mania, or a combination of the two, are hallmarks of bipolar disorder, a serious, long-term psychiatric condition. The first step to accurately diagnosing bipolar I or II disorder is identifying current or previous manic, hypomanic, or depressive episodes. This type of mood episode has specific diagnostic criteria and clinical probes for identifying key symptoms. Bipolar disorder subtypes Bipolar-I and Bipolar-II and cyclothymic disorder, intermediate phenotypes of the disorder frequently encountered in clinical practice, can be diagnosed using the DSM-5 criteria.
Manic Episode
The client was experiencing a distinct period of abnormally elevated, irritable mood, lasting for at least one week (Mohammadi et al., 2018). The client has mood swings most of the day, taking 10 to 15 minutes to cry in the bathroom nearly daily.
The patient experienced the following symptoms during the period of mood disturbances and also presented a significant level of behavioral change:
The client declined invitations by co-workers to happy hours and social events; hence, an indication of social isolation due to low self-esteem
The client has a decreased need for sleep as she spends most evening times watching television
The disorder makes the client have subjective experiences
The client is overwhelmed with sadness, distracted, and faces psychomotor agitation
The mood disturbance is severe to cause marked impairment in social functioning
The client’s episode is not attributed to substance psychological effects or medical condition
Client Resources/ Competencies
The client is educated as she has recently graduated with a degree in civil engineering
The client has employment in an engineering firm in Manhattan
The client is financially-able and can make positive decisions about her life. She plans to move to New York after getting the job
The client has a loving and caring family, workmates, and friends, who support her achievements and are concerned about her social life
Goals and Objectives/Measurable Outcomes
The client will demonstrate a reduction of subjective experiences and sadness by 80% within six months:
Monitor the mood by improving the sleeping period to five hours every night
Develop a schedule. Routine is vital in keeping your mood consistent. Organize a timetable and attempt to keep to it regardless of the mood to maintain consistency.
Limit stress by having reduced pressures in life
Build an excellent support network. Allow family and friends to assist in managing your day-to-day symptoms by offering an outsider’s viewpoint on your mood.
Engage in physical exercise 2 to 3 times a day for 30 minutes since exercise is effective as a technique to help control mood.
Treatment/Intervention Frequency and Duration
Family-Focused Treatment
Family-focused treatment is based on the widely reproduced relationship between criticism and anger in caregivers and an increased chance of relapse in mood disorders. Family-focused therapy involves the patient and caregivers in up to 21 sessions of psychoeducation, communication skills training, and problem-solving skills training (Miklowitz et al., 2020). The intervention should take 2-3 times a week, including family meetings, to improve the client’s social interaction.
Cognitive-Behavioral Treatment
Cognitive-behavioral treatment presumes that recurrences of mood illness are governed by pessimistic thinking in reaction to life events and basic dysfunctional beliefs about the self, the environment, and the future. Cognitive-behavioral treatment to treat depression has been developed for individuals with bipolar illness, with the knowledge that manic periods are typically linked with overly positive thoughts (Furukawa et al., 2021). CBT is an evidence-based treatment that involves 12 to 16 weekly sessions depending on the degree of the manic episode. CBT has greater efficacy for all mental diseases than psychoanalysis and person-centered treatment. Hence, it will help recognize unhealthy, negative ideas and habits and replace them with healthy, constructive ones. CBT can assist in discovering what triggers bipolar episodes and useful techniques to control stress and cope with stressful events.
Evaluation
Cognitive stimulation therapy (Furukawa et al., 2021):
CST enhances patients’ quality of life as it provides favorable effects on cognition improvement
The technique exhibits more notable cognitive gain in females than males and elderly persons than the younger age group.
CST enhances patients’ attention, and alertness boosts willingness to engage in conversation or socialize and improves memory.
The treatment technique is cost-effective
The problem with CST is that it is only influential on particular cultures.
The strategy displays efficacy in household situations. Older patients prefer a customized therapy method versus group-based therapy.
References
Furukawa, T. A., Suganuma, A., Ostinelli, E. G., Andersson, G., Beevers, C. G., Shumake, J.,… & Cuijpers, P. (2021). Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data. The Lancet Psychiatry, 8(6), 500-511.
Miklowitz, D. J., Schneck, C. D., Walshaw, P. D., Singh, M. K., Sullivan, A. E., Suddath, R. L.,… & Chang, K. D. (2020). Effects of family-focused therapy vs enhanced usual care for symptomatic youths at high risk for bipolar disorder: a randomized clinical trial. JAMA psychiatry, 77(5), 455-463.
Mohammadi, Z., Pourshahbaz, A., Poshtmashhadi, M., Dolatshahi, B., Barati, F., & Zarei, M. (2018). Psychometric properties of the young mania rating scale as a mania severity measure in patients with bipolar I disorder. Practice in Clinical Psychology, 6(3), 175-182.
Myczkowski, M. L., Fernandes, A., Moreno, M., Valiengo, L., Lafer, B., Moreno, R. A.,… & Brunoni, A. R. (2018). Cognitive outcomes of TMS treatment in bipolar depression: safety data from a randomized controlled trial. Journal of affective disorders, 235, 20-26.
Article “Paranoid Schizophrenic Set Fire to Herself After Years of Suicidal Thoughts”
In the article, the woman was suffering from such symptoms as suicidal thoughts, delusions and hallucinatory experiences when she thought she had two sets of parents or that “her pet dog had been replaced by an identical animal”. (Paranoid schizophrenic set fire to herself after years of suicidal thoughts, para 3.). Moreover, she has pseudohallucinations, which are false auditory perceptions of a strange nature that were telling her to kill herself (Paranoid schizophrenic set fire to herself after years of suicidal thoughts). The official diagnosis reported in the media was paranoid schizophrenia accompanied by psychotic episodes.
The report creates an impression of the woman being completely inadequate and dangerous. It highlights moments like the one when the woman poured wax on her head and tells nothing about days when she did not have psychotic episodes (Paranoid schizophrenic set fire to herself after years of suicidal thoughts). The article tries to bring home to the reader the idea that the woman was also suffering from an emotional-volitional defect, which manifests itself as a lack of strong-willed qualities and complete indifference to the outside world. This was expressed by the loss of the ability to show tenderness, affection, sympathy, affection, tact to her family who kept her out of madhouse. The woman showed neither gratitude to her parents nor compassion when she tried to kill herself many times knowing what anguish her death would be to her family.
In the textbook, paranoid schizophrenia is described a little differently. While it is mentioned that the person has auditory hallucinations, it is said that these are centered around the themes of grandeur or prosecution (Coon & Mitterer, 2013). In addition, it is said that when a paranoid schizophrenic does not have psychotic episodes, he or she has no more propensity for violence than ordinary people. Thus, the description in the media is consistent with the textbook only partially. While auditory hallucinations are described in both sources, the article concentrates around abnormal and dangerous behavior of the woman and tells nothing about quieter episodes described in the textbook.
Article “Twitter Sends Support to Mariah Carey, Who Opens Up About Her Mental Disorder”
In this article, the symptoms the pop diva include severe mood swings when the mood for several months, weeks, or for a few hours “goes to extremes” — it becomes too cheerful and too bad. The singer has mentioned “sharp switches of mood from euphoria or irritability to depression, as well as insomnia, weight loss or gain, and suicidal intentions” that bother her (Twitter sends support to Mariah Carey, who opens up about her mental disorder). Moreover, the article highlights the singer’s “inconsistent performances and her relationship troubles” (Twitter sends support to Mariah Carey, who opens up about her mental disorder) that she has had over the last fifteen years. The singer was even accused of sexual harassment of her bodyguard. The mentioned symptoms are consistent with the bipolar II disorder – a diagnosis mentioned in the media. However, while there are certain similarities between this description and the one provided in the textbook, there are certain differences as well.
The report creates an impression of a person whose emotions are amplified: joy — to euphoria, irritation, and resentment — to aggression, suspicion — to paranoia. Physical activity also increases: the singer almost does not want to sleep. The singer’s behavior can be characterized as impulsive, reckless, sometimes even adventurous, and eccentric. Another sign of bipolar disorder described in the media is that the pop diva has had depression, from mild short-term to severe long-term.
The description is partially consistent with the one provided in the textbook. Thus, bipolar disorder is described as episodes of depression, mania, hypomania, and mixed episodes (Coon & Mitterer, 2013). According to the textbook, bipolar II disorder, specifically, is the feeling of “fatigue and emptiness” that periodically lapses into cheerful and energetic mood (Coon & Mitterer, 2013, p. 505). While the media mention insomnia as a symptom of bipolar II disorder, in the textbook it is attributed to bipolar I disorder. Thus, the portrayal of the disorder in the media is the mix of symptoms that belong to bipolar I and II disorders in the textbook. Coon & Mitterer (2013) state that variations of certain conditions of bipolar I and II disorders can be diverse, including the intensity of manifestations of symptoms, the course of the disease, changes in episodes. At the same time, depression and mania in the clinical sense are understood as opposite to each other “peak” affective states. They can last quite a long time, occur with a regular frequency and be of various “depths”. The portrayal of pop-diva’s life and character when she has been involved into different scandals in consistent with this description. Thus, her mood changes have led to conflicts in the family, at work and in society.
The portrayal of mental disorders in the media differs from the one presented in the textbook. While Coon & Mitterer (2013) are objective describing positive as well as negative symptoms of mental deceases, the media tends to demonize mentally ill people, speaking about their misconduct, strange ideas or perceptions. To make media coverage more objective, the society should work towards elimination of stigma towards mentally ill people in all spheres of life.
Despite the high prevalence of mental illness, the treatment of mental health remains dynamic, with new views developing psychiatric care will likely develop progressively individualized in the future. This research evaluates the present National Health Service (NHS) website for health information and provides improvements. As given on the NHS Health A-Z listing, the primary focus is on bipolar disorder. The proposed modifications include using psychedelic therapy, virtual reality technology in healthcare, applying Neuralink science to health management, and adopting a spiritual perspective. The proposals are sent to the Department of Health of the NHS for review.
The Validity and Practicality of Current NHS Information
Validity of Current NHS Information
The NHS defines bipolar disorder as a psychiatric condition characterized by significant mood swings. The NHS website describes the manifestations of bipolar disorder, including sadness, feeling, anger, and mania, which results in highly high hyperactivity. According to the NHS, bipolar illness is first diagnosed as depressive disorder preceding a manic episode. During a depressive episode, the patient has overwhelming emotions of unworthiness, which may lead to suicidal ideation.
During a manic phase of bipolar illness, according to the NHS, the patient may experience extreme happiness. Patients have great energy, grandiose ideas and goals, and a tendency to spend a disproportionate amount on activities they might not afford. The patient often views the manic episode of bipolar disorder as a pleasant experience and a time of great creativity. Regarding treatments for bipolar illness, the NHS recognizes that manic and depressive episodes are often so intense that they interfere with daily living. However, the website notes various effective treatment options for bipolar illness. Therapy aims to mitigate the consequences of an episode and let a person with bipolar illness lead everyday life as feasible. According to the NHS, the therapeutic options include mood stabilizers for preventing manic and depressive episodes. Long-term treatment for the significant symptoms of depression and mania requires daily medication administration.
The NHS advises a specialized examination for the diagnosis of bipolar disorder, in which the psychiatrist should present questions to determine whether the patient exhibits bipolar disorder symptoms. The psychiatrist would inquire about the patient’s feelings before and during a manic or depressive episode. The psychotherapist will be interested in the patient’s past medical history and genetic predisposition, particularly if any siblings have bipolar illness. The NHS suggests further tests that may reveal any medical condition, such as an underactive or hyperactive thyroid. The NHS recognizes in advance directives that patients may not be competent to make an educated choice about their treatment or convey their requirements, particularly if their conditions become acute. In such circumstances, the NHS suggests drafting a treatment choice in the form of written instructions.
The NHS provides scientifically sound findings derived from extensive studies. Bipolar illness is a biopsychosocial condition, and the suggested intervention suggests that successful customized therapy may aid in its management. The emotional state-altering drugs emerge as the cornerstone of NHS therapy. In pharmacology, these drugs are classified into three groups: lithium, antiepileptic agents, and antipsychotics of the second generation (Incecik et al., 2020). Experiments demonstrate that the processes by which these drugs exert their effects are diverse and include the elevation of serotonin, aminobutyric acid, and central nervous system neurotrophic factor. The NHS intervention suggestions are well-founded since the drug may aid in reducing glutamate levels, hence modifying dopamine connections and stabilizing neuronal membranes.
The NHS provides relevant provisions for bipolar disorder since the insights share scientific truths with most mental health literature. The National Health Service correlated bipolar disorder with a condition of temperament and social interaction issues that could be derived from bipolar disorder-related personality issues in mental health. The criteria recognize that an individual with a disorder would think, interpret, feel, and interact with others markedly differently from the ordinary individual. According to the NHS, the disease is characterized by emotional instability, altered patterns of thought, impaired judgment, and impulsive behavior (Gordovez & McMahon, 2020). According to the NHS, psychopathological symptoms may vary from minor to severe and often manifest in adolescence and last throughout adulthood.
The National Health Service admits that the etiology of bipolar-related mental health issues requires further clinical research. However, the NHS recognizes that bipolar disorder seems to be caused by a mix of hereditary and environmental factors, as is the case with other diseases. In psychiatry, bipolar disorder patients’ treatment comes from diverse origins, but most will have suffered trauma or maltreatment as children (Incecik et al., 2020). The website emphasizes that diagnosing bipolar disorder requires ruling out other more prevalent mental health problems, such as depression, and ensuring that there is no urgent threat to the patient’s well-being.
Regarding bipolar disorder therapy, the NHS adds that many patients might benefit from timely psychological and medical care that reflects their interpersonal needs. The medicine may consist of various individual and group psychological treatments administered by qualified experts working as part of a community mental wellness team. The therapy includes the management of mental health issues such as alcohol abuse, chronic anxiety, and disordered eating patterns such as anorexia. The NHS recognizes that other bipolar disorder-related personality disorders, such as antisocial disorder, must be carefully handled to prevent the recurrence of symptoms. The NHS reports that many individuals with mental health diseases improve from their symptoms over time. People whose symptoms reoccur are advised to undergo further therapy.
The NHS guidelines may be categorized as commonly acknowledged bipolar disorder treatment interventions, including dialectical behavior therapy and mentalization-based therapeutic support. In practice, dialectical behavior therapy combines group and individual treatment to educate the patient on how to control emotions, endure suffering, and strengthen relationships via a skills-based approach. Schema-focused treatment is used to assist in uncovering unmet requirements that have led to poor life patterns useful for survival at one point in the patient’s life but are now detrimental. The follow-up treatment is centered on assisting the patient in healthily meeting their needs to foster beneficial life patterns. According to the NHS, mentalization-based treatment is a kind of talk therapy that helps bipolar disorder patients in identifying their ideas and emotions to develop an alternative viewpoint on the issue.
The Practicality of Current NHS Information
With the present health care system, several NHS mental health interventions for mental health situations are feasible. The findings are remarkably consistent with the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM-5).aSaM-5 presently classifies five forms of bipolar and associated disorders: bipolar 1, bipolar 2, cyclothymic disease, further defined bipolar and related abnormalities, and unexplained bipolar and similar ailments. Bipolar 1 and 2 are the most prevalent, with manic episodes being more pronounced in bipolar 1. Studies have shown that bipolar 1 and bipolar 2 syndromes have many characteristics, with the primary distinction being that bipolar 1 needs at least one manic episode. The NHS provides diagnosis and intervention positions that reflect the need for such dynamic nature of the disease, making the guidance practical in psychiatric care.
Similarly, both the NHS and the DSM-5 advocate screening people with bipolar illness suspicions. The protocols included guidelines for excluding other mental diseases or sources of symptoms and a complete evaluation of the patient, the patient’s family medical history, drug use history, living environment, and current caretakers or legal representatives. The NHS and DSM-5 both urge a comprehensive history of the sort of the first episode. The NHS emphasizes the primary polarity of sickness, the length of episodes, severity, and the period between episodes. DSM-5 requires the management of suicidal conduct, a background of violence, and the presence of fast-cycle characteristics.
The NHS offers informed insights and recommends differential testing to rule out alternate causes, such as clinical depression, chronic anxiety, and posttraumatic stress syndrome. The NHS treats bipolar illness produced by managing attention deficit hyperactivity disorder (ADHD) and antisocial behavior. Examining the appearance, emotions, thinking content, thinking processes, perception, cognition, and judgment is a crucial care intervention throughout the diagnostic process. The NHS provides standardized measures similar to the DSM-5 for evaluating bipolar disorder may aid the clinician in getting the specific data required for an evaluation.
The NHS recognizes the need for accurate data in examining nonpharmacologic and interpersonal therapeutic intervention recommendations for treating bipolar illness. According to the NHS, psychoeducation and counseling as a supplement to pharmaceuticals may be beneficial during the acute phase and maintenance treatment of bipolar disorder. Such approaches may minimize relapse risk and improve medication adherence. The NHS recognizes the social rhythm concept, psychosocial interventions, and rehabilitation programs as practical examples. Psychiatric care’s modern medical technology allows for such interventions.
Similarly, the NHS offers pharmaceutical recommendations for Manic, Hypomanic, and Mixed Episodes that are scientifically congruent with the DSM-5 criteria. In situations of severe manic episodes and dissociative symptoms, the American Psychiatric Association’s practice recommendations suggest initiating lithium plus an antipsychotic and valproate plus an antipsychotic. If a patient is unwilling to take oral drugs, the National Health Service recommends depot antipsychotics. In most cases, olanzapine, quetiapine, and aripiprazole were used to treat bipolar disorder. Such medications are available at the majority of healthcare institutions.
From the standpoint of pharmaceutical therapies, the NHS interventions for bipolar illness and BPD are practical and scientifically accurate. Current research supports antipsychotics olanzapine, quetiapine, and ziprasidone (Xia & Jayakumar, 2021). The NHS adds that the initial stage in treating patients with recurrent manic or hypomanic episodes is optimizing the continuing agent. Monitoring blood levels of agents such as lithium or valproate may lead to optimization. The HNS acknowledges that depending on the event’s intensity, antipsychotics and benzodiazepines may be added whenever required.
The NHS information assists in establishing the context of each visit by concentrating on occupational, social, familial, and health status changes. The NHS’s focus on providing drug tolerability and patient attitudes reflects patient-centered treatment requirements. The NHS stresses that people with mental illness must be aware of early indicators of mood shift and, if required, adapt their prescriptions since treatment methods must often be modified. The National Health Service facilitated the optimization of mood stabilizers with combination treatment for durable remission. Antidepressants may exacerbate the progression of the condition, and a meaningful trial of a mood stabilizer cannot be conducted in the presence of antidepressants.
The NHS suggests that, in the event of suicidal thoughts, the sufferer study up on where to get immediate mental health assistance. In the event of acute depression, victims are encouraged to call a primary care physician, a care coordinator, or the local mental health crisis team. The local NHS hotline for mental health emergencies is available on the website. According to the NHS, people may phone NHS 111 if unsure of what to do or if they cannot reach their local NHS mental health hotline. If the patient requires anonymity, the NHS suggests phoning the Samaritans on their toll-free number 116 123, which is accessible 24 hours a day, seven days a week.
Recommended Changes
Despite the scientifically sound and practically applicable NHS regulations on bipolar disorder intervention, there may be places where adjustments are necessary to maximize the effect of the advice on mental health patients and their caregivers. The NHS webpages, for instance, make no mention of the developing science of psychedelics in the treatment of mental health disorders. The NHS should recognize an emerging narrative concerning using two atypical psychedelics and one classic psychedelic in managing bipolar illness. Emerging therapeutic frameworks have the potential to revolutionize the administration of mental health treatment.
Recommended Changes
Introduce words
Utilization of Psychedelic Treatment
Adopting Spirituality for Religion among Patients
Virtual Reality Therapy
Using Virtual Reality Technology in Healthcare
Neurolink science
Employing Neuralink Science in Health Management
VR therapy
Utilization of Psychedelic Treatment
Some medications, for instance, have been shown to modify the state of consciousness of patients, creating an alternate world that may be employed to alleviate their misery. According to studies, psychedelics have seen a rebirth in biology and medicine (Xia & Jayakumar, 2021). In the research, lysergic acid diethylamide (LSD) is considered psychedelic. In the studies, stimulation of serotonin 2A transmitters in cortical regions induces distinctive effects, such as modifications in sense perception self-processing. As such, the intervention directly affects the patient’s awareness, which can be altered to generate a sense of an alternative reality that is preferable from the distressed patient’s perspective.
The emerging field of psychedelic-assisted psychotherapy proposes a therapeutic approach in which a safely administered psychedelic experience is included in an ongoing psychotherapeutic practice. In one research, controlled studies using psilocybin demonstrate promise effectiveness, convenience, and adherence for treating major depression and bipolar disorder (Incecik et al., 2020). The work relies heavily on the 1943 discovery of LSD by Swiss chemist Albert Hofmann (Gordovez & McMahon, 2020). The discovery sparked a global interest in the substance’s unique effects on the human mind and its potential medicinal applications and scientific significance. It is regarded as the prototypical psychedelic substance. Researchers have recently established that traditional psychedelics are connected with the production of mania, a crucial factor to consider when designing research and therapeutic procedures.
These insights should influence modifications to the NHS website that highlight how the science of consciousness and psychedelics might provide comfort to distressed patients. The investigations demonstrate that atypical psychedelics are diverse groups with overlapping subjective effects. Exploring the many neurobiological pathways that might perpetuate mania to enhance the patient’s quality of life. The psychedelic therapy treatments provide the first evidence of ketamine’s therapeutic benefit in bipolar depression (Xia & Jayakumar, 2021). The NHS must acknowledge that psychedelics have the potential to meet alignment and be integrated into more significant therapeutic usage. A well-considered clinical and legal environment will be essential for developing novel treatment settings and a possible paradigm change due to these drugs.
Using Virtual Reality Technology in Healthcare
Similarly, the NHS should investigate the science of VR and its influence on managing the mental health of people with bipolar disease. Virtual Reality Therapy (VRT), like traditional anxiety-treatment approaches, involves exposing individuals to their anxiety triggers in a supervised condition (Incecik et al., 2020). As with most treatments, VR-based patient management aims to train patients to react favorably to situations that trigger their specific fear. The intervention may assist individuals suffering from physiological stress related to the initial trauma that created their anxiety problem.
The immersive and interactive capabilities of VR provide various advantages over traditional treatments. For instance, virtual reality technology allows mental health professionals to create highly tailored treatment regimens based on the specific requirements of their patients. In offering patients more control over their exposure, the VRT has shown to be superior to traditional therapy procedures. From the patient’s viewpoint, VR experiences may be made to be very engaging, which is crucial for retaining a sensation of control even when anxiety triggers are experienced. The strategy incorporates modern science in electronics and internet technology and is accessible to most patients who may obtain the technology through the global technology marketplaces.
From experience, patients appreciate that VR mental health care intervention gives a drug-free technique for decreasing trauma-related anxiety. The NHS should understand that a well-designed VR treatment program can offer enhanced operational optimizations over conventional therapeutic intervention. The interactive power of VR provides a more interactive connection with the context of the situation resulting in more outstanding performance. Equally, unlike typical anxiety-therapy programs, VR applications permit patients to complete their therapy at home, which considerably boosts the long-term success of the support. Despite the promise of revolutionizing mental health care, the NHS should recognize that VR therapy will not replace traditional treatment approaches in all situations. However, the technology provides promising benefits over typical therapies.
Employing Neuralink Science in Health Management
Neuralink employees emphasize that cybernetics might expand, repair, and modify human skills. Researchers started inserting probes into the brains of paraplegic patients. The Neuralink technology provided comparable progress to technology with direct influence on the functioning of the neural network in the late 1990s to prove that signals might help them manipulate robot arms or computer cursors (Gordovez & McMahon, 2020). The firm is designed to build ultra-high frequency brain-machine interconnections to link humans and machines. The business is creating technology predicated on the notion that every emotion a person has felt in their life is simply basic electrical impulses.
The notion proposes a new method of controlling cognition as an electrical signal that may be produced. According to the Neuralink technology teams, the brain’s activity may be managed with electrical impulses inducing targeted desires inducing regulating the symptoms of mental health conditions such as bipolar disorder (Incecik et al., 2020). Neuralink management has planned further to improve such central nervous system interfacing to the point that one may be placed under an hour (Incecik et al., 2020). The NHS needs to acknowledge the influence of modifying the brain’s electrical signal using technology such as Neuralink to control bipolar disorder.
Adopting Spirituality for Religion among Patients
Finally, the NHS should understand the distinction between religion and spirituality in treating the mental health and perspective of reality among its patients. Today, conventional religious beliefs such as Christianity and Islam rely on a human being primarily from the outside looking subject of God anxious for redemption. But the conceptions of spirituality such as those in Hinduism and Buddhism emphases on people as superior beings with exclusive control over fate. The principles of spirituality support examining the power of drugs with the assumption that all the answers individuals seek are inside.
Meditation is emphasized in Hinduism and Buddhism as a cognitive control technique that might enhance the present viewpoint. Initially, the purpose of meditation was to improve comprehension of the holy and mystical elements of existence (Xia & Jayakumar, 2021). Meditation is being used for relaxation and stress reduction. Meditation is considered a kind of complementary mind-body treatment (Miller & Black, 2020). Meditation may induce a state of profound relaxation and a calm mind. During meditation, the patient is instructed to concentrate their attention and remove any disorganized thoughts that may be generating stress. The NHS should acknowledge that such processes have a tight relationship with the concept of the inner world and may result in improved physical and mental health.
Several researchers have acknowledged the advantages of meditation in enhancing patients’ quality of life with bipolar illness. Studies have shown, for instance, that meditation may provide mental health patients with a feeling of quiet, tranquility, and equilibrium, which can enhance both their emotional and physical health. Patients may use Buddhist teachings to relax and manage stress by redirecting their attention to something tranquil and maintaining their concentration on thoughts that provide a pleasant sensation and sense of security. The NHS should recognize that meditation may assist individuals with bipolar illness in learning to remain focused and maintain inner serenity.
Conclusion
The NHS collaborates with other organizations to provide mental health care across England. They may be charities, for-profit businesses, or non-profit organizations. They are referred to as service providers. Mental health has become the area of the NHS and social care that the public is most concerned about and wants to see better, with treatment delays and inadequate assistance for those in need being their primary worries. Although the NHS website provides substantial guidance on treating mental health conditions such as bipolar illness and bipolar disorder-related personality disorder, there may be a need to update the advice. The proposed modifications include using psychedelic therapy, virtual reality technology in healthcare, applying Neuralink science to health management, and adopting a spiritual perspective. Adequate care for bipolar illness may significantly enhance the mental health of victims.
Miller, J. N., & Black, D. W. (2020). Bipolar disorder and suicide: a review. Current Psychiatry Reports, 22(2), 1-10.
Incecik, E., Taylor, R. W., Valentini, B., Hatch, S. L., Geddes, J. R., Cleare, A. J., & Marwood, L. (2020). Online mood monitoring in treatment-resistant depression: a qualitative study of patients’ perspectives in the NHS. BJPsych Bulletin, 44(2), 47-52.
Since she was a teen, Vee has engaged in non-suicidal self-injury, notably slashing her arms and legs. Vee admits that she can “get lost” during conversations or at work when she is worried. She reports a long-standing habit of switching her interests and, sometimes, her career, depending on who is in her societal circle. She feels her spouse is the finest thing that has happened to her at times and spontaneously purchases him expensive presents. However, sometimes, she cannot tolerate him and would either disregard him or strike out at him, shouting or tossing things. She recounts experiencing sorrow and dread at the prospect of him abandoning her immediately after doing so.
It would be reasonable to claim that in Vee’s case, the diagnosis is bipolar disorder. This disorder is characterized by mood swings that are different from the usual ones. Depressive, manic and mixed states replace each other; sometimes, asymptomatic periods or phases can be observed when symptoms are mild (American Psychiatric Association, 2013). In the manic stage, the mood is either too good or agitated. In the phase of depression, the patient often experiences feelings of guilt and worthlessness. These primary features are apparently present in Vee’s anamnesis, which confirms bipolar disorder. A differential diagnosis might be a Major Depressive Disorder, given that a patient’s mental state may also express hypomanic or manic symptoms.
At this point, it seems reasonable to specify Vee’s diagnosis and define its affiliation. Vee is likely to be affected by Bipolar I Disorder, given that the following criteria are met for the manic episodes. First, a distinct duration of excessively high, expansive, or irritated mood lasts at least one week and is present for most of the day (American Psychiatric Association, 2013, p. 124). Second, during altered mood and enhanced energy or activities, Vee is more chatty than usual, has a lot of thoughts, and is easily distracted. Third, the mood disorder is severe enough to limit societal or occupational performance significantly. Fourth, the incident is not caused by a substance’s health consequences. In order to provide specifications on the mentioned diagnosis, it is essential to put Vee in a clinic to supervise the manifestations of the symptoms on a daily basis (World Health Organization, 2016). Preliminary, it might be assumed that Vee has Bipolar I Disorder – manic episodes with mixed features.
Bipolar disorder is usually treated with mood-stabilizing drugs called second-generation antipsychotics. One can also use medications to relieve anxiety and insomnia and antidepressants during the depressive phase (Durand, Barlow, & Hofmann, 2018). Finding the right medications for bipolar disorder can take some time, but the right medications effectively prevent and alleviate the depressive and manic stages. It may be necessary to change the drugs and their doses several times before the necessary ones are determined. Sometimes a combination of several drugs is the best option.
In bipolar disorder, drug therapy may continue for several years in the form of so-called maintenance treatment. Long-term drug therapy is not necessary unless the symptoms are severe and the person with bipolar disorder is able to control them reasonably well (American Psychiatric Association, 2013). The second treatment option is prophylactic treatment in cases where the patient has learned to recognize the approach of the manic phase. One should learn to recognize the symptoms that portend various periods of the disease. In this case, the feeling of control increases, and even with the disorder, one can live a normal life. To avoid the occurrence of painful stages, it is important to avoid excessive stress and insomnia.
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). New York, NY: American Psychiatric Publishing.
Durand, V., Barlow, D., & Hofmann, S. (2018). Essentials of abnormal psychology (8th ed.). Boston, MA: Cengage Learning.
